Thread by @fascinatorfun

Coronavirus Can Be Stopped Only by Harsh Steps, Experts Say - The New York Times

Very good article indeed. Although centred around the US there is plenty in it for everyone. nytimes.com/2020/03/22/hea…

It summarised S Korea’s response that they built on the back of errors they made in MERS and western countries are repeating.

They knew it was coming their way in December.

Government isolation centres were prepared
Phone credit card data used to trace movements & find contacts

Those data are used to geographically locate when and where that person walked and those data are streamed into people’s phones so they are alterted and know where to avoid and to consider if they may be at risk.

Once China realised it had a really serious problem they set up fever clinics & telemedicine consultations. A nurse would carry out a consultation on the phone and decide if you needed a test . Then directed you to the fever clinic.

Full Hazmat gear for personnel who would carry out rapid tests to rule out flu and bacterial pneumonia .

Next mobile CT scanners used to check for ground glass opacity (a feature of COVID.

Only then a test.

At least a four hour delay and sometimes overnight (as they do the proper RT-PCR test recommended by the WHO - NOT pinprick IgG/IgM). They may decide a retest is needed as it can take days for the virus to fully develop and produce a +ve test.

You might then be sent to a hotel

The US is struggling with the issue of isolation. The Chinese data indicated that 75-80 of infection was transmitted within families.

Indeed 7 members of one family in New Jersey have contracted COVID, 4 dying the others seriously ill.

They (& UK) need isolation ward capacity

Fever checks are routine on public transport and in offices & restaurants in China, Twiawan, Vietnam and S Korea (& Singapore) countries that have had to wrestle with SARS and MERS.

Hand washing in chorinated water also required

In China a fever means a mandatory trip to a fever clinic & police might come knocking on your door to take temperatures with resisters sometimes being dragged away

Some cities offered bounties to those that turned in CV19 sufferers

Others rewarded those who came in for tests

Although this article says Wuhan had 18000 people tracing and tracking contacts, an account by one of their public health official said they had 18000 teams each of at least five people.

I

I do not know how many S Korea had on the job, but neither the US nir the U.K. currently have the manpower to do this on a large scale (although the U.K. certainly did do it in the early weeks of this outbreak)

In Singapore classes photos are taken to aid tracing if one has CV

The jury is out on the efficacy of masks for routine use.

It is a cultural and social imperative in parts of Asia and also to encourage those who have a cough to wear one - without being singled out.

Here are we in the U.K. talking about 5k ventilators in the whole of the U.K.

The US, about 5 times the size of the U.K. has 175k.

That would be roughly equivalent to 35k here.

New York State (pop 19.8 million) that has been so badly hit, thinks it needs 30k

Cost 25k each

We aren’t alone in trying to get other manufacturers to turn their hands to a crude ventilator..

But China learned that many patients that would normally have been ventilated recovered with oxygen treatment alone.

China succeeded by mounting a huge volunteer force, fever checked, tracers, hospital construction workers, food deliveries, baby sitting first responders’ children, basic nursing and lab work.

Numerous “off license” application of medications have been tried but their efficacy is not proven. (However the WHO has set up a series of clinical trials (not double blind) to ensure that better and more systematic assessment if efficacy can be carried out,

Another possibility for any second wave, especially for front line workers is to harvest protective antibodies from survivors of the illness, purifying blood serum to be used in small quantities.

But the same dilemma. They need enough survivors first.

A reminder why vaccines cannot be rushed. Once administered it takes weeks for the human body to produce antibodies & some dangerous side effects can take weeks to appear...hence starting with 50 healthy individuals. Check for side effects and dosage

Only then full clinical trials with hundreds of thousands enrolled, 50% getting the vaccine 50% not
If the 50% that get it are protected then it gets the green light

Some will remember vaccines developed that resulted in Guillane-Barr syndrome that can result in paralysis/death

Accelerated trials when there is no cure is ethically fraught given that even young people have suffered severe symptoms & some have died.

Turns out that wealthy, privileged countries are less good at following WHO advice than poor and middle income countries

That must change